Disorganized Attachment Research Articles

Variants of Callous-unemotional traits in childhood: investigation of attachment profile and hostile attribution bias

ABSTRACT There is increasing evidence of interest in describing two variants of CallousUnemotional (CU) traits based on high (secondary variant) or low (primary variant) levels of anxiety. However, studies are limited in childhood. The present study aimed to further the understanding of the variants, specifically in association with hostile attribution bias (HAB) and attachment. In a community sample of children aged 4 to 9 (N = 70), the study examined whether anxiety moderated the association of CU traits with HAB, secure and disorganized attachment representations. Hierarchical regression analyses revealed that CU traits were positively associated with disorganized attachment, regardless of the anxiety level. In contrast, CU traits were not associated with secure attachment. A significant interaction revealed that CU traits were positively associated with HAB only at high levels of anxiety. Implications for understanding the variants of CU traits and hypotheses regarding their developmental trajectories are discussed.

Attachment Stability and Longitudinal Prediction of Psychotic-like Symptoms in Community Adolescents over Four Months of COVID-19 Pandemic.

Background: The Friends and Family Interview (FFI) is assumed to be a valid method to study attachment stability and attachment-related psychopathological processes in adolescence, but no studies have yet tested the test-retest reliability of this interview or the longitudinal association of attachment patterns in response to the FFI from adolescents with symptoms such as psychotic-like experiences (e.g., hallucinations, bizarre behavior, dissociation, self-harm) that are known to have increased during the COVID-19 pandemic. Methods: This study involved 102 community adolescents (M = 14.64, SD = 1.63, 46% males) assessed twice: during a severe COVID-19-related lockdown (in Italy) (T1) and four months later (T2). Measures were the FFI (assessing attachment patterns: secure-autonomous, insecure-dismissing, insecure-preoccupied, and insecure-disorganized) and the thought problems scale of the Youth Self-Report to assess psychotic-like symptoms. Results: revealed high stability of four-way attachment classifications over four months (93.5%), with a modest yet significant link between higher disorganization at T1 and higher scores of thought problems at T2, p = 0.010. Conclusions: The FFI shows high test-retest reliability and can be a valid, age-adapted option to assess adolescents' attachment. Attachment disorganization should be further investigated as possibly related to psychotic-like experiences in community adolescents.

Infant and preschool attachment, continuity and relationship to caregiving sensitivity: findings from a new population-based Australian cohort.

Here, we report new prevalence and temporal stability data for child attachment and parental caregiving behaviour, from infancy (1 year) to preschool (4 years). Attachment (SSP) and caregiving data (MBQS) were from observations of parents and their infants and preschoolers, who represent the third generation of participants within an Australian longitudinal cohort. At 1 year (n = 314 dyads) and at 4 years (n = 368 dyads), proportions assessed secure were 59% and 71%, respectively. Proportions assessed avoidant were 15% and 11%; ambivalent 9% and 6%, and disorganised 17% and 12%, at 1 and 4 years. Continuity of attachment pattern was highest for the infant secure group. Of dyads initially classified disorganised in infancy, 36% remained so at the preschool assessment. Attachment and caregiving continuities across the infancy-preschool period were highest for the stable secure attachment group and lowest for the stable insecure attachment group. Loss of secure attachment to mother by age 4 years correlated with decreased maternal caregiving sensitivity, and acquisition of secure status by age 4 was associated with increased maternal sensitivity. We found no difference in caregiving sensitivity scores for mothers and fathers for female and male preschool children. The contemporary infant and preschool attachment proportions we report here closely mirror the patterns of those reported in prior decades, with an inclination towards secure base relationships. Our findings alert practitioners anew to the responsiveness of early attachment status to change in caregiving responsiveness and support ongoing investment in early identification of disorganised attachment.

Borderline personality - from psychoanalysis to epigenetics. Biological basis of attachment.

In terms of object relations theory, borderline personality disorder (BPD) is characterized by a structural abnormality of identity, conflicting representations of self and others, and disorganization of attachment - a construct rooted in an individual's early experiences and central to the relationships established later in life. A special role in the formation of attachment style is attributed to the relationship with the caregiver and to difficult experiences or traumas from early developmental stages. These experiences not only provide the psychological basis for the development of an insecure attachment style, but also leave a biological mark in the body in the form of epigenetic modifications. Although research on epigenetic modifications in BPD is scarce, a growing body of evidence supports the importance of oxytocin - the "social peptide" underlying attachment - in the etiology of BPD. We believe that the study of epigenetic modifications that affect the action of oxytocin in the BPD clinical population will provide a better understanding of the basis and process of development of the disorder, as well as provide a therapeutic direction to work effectively in the major areas of BPD.

Antibiotic Consumption, Illness, and Maternal Sensitivity in Infants with a Disorganized Attachment.

Prior research found an association between mother-infant attachment and antibiotic use. Ambivalent-attached infants are more likely to take antibiotics than other infants, and their mothers tend to be less sensitive to their needs than most. This finding is important because it shows the association between psychological processes, early relationships, and health outcomes. We aim to learn about children with high-risk attachment relationships, such as disorganized-attached infants. This study compares antibiotic use, infant-mother interactive behavior, and health indicators according to infant attachment patterns (including disorganized attachment). For this purpose, we observed mothers-infants' interactive behavior in free play at nine months and infants' attachment in the Ainsworth Strange Situation at twelve months. Participants included 77 girls and 104 boys (full-term and preterm) and their mothers. Paradoxically, mothers of disorganized-attached infants reported that their children were ill only 1.56 times on average, but 61% of their children used antibiotics in the first nine months. The other mothers reported that their children were sick 5.73 times on average, but only 54% of their children used antibiotics in the same period. Infants with disorganized attachment had mothers who were more literate and less sensitive. These results add to a body of research that shows that early high-risk relationships affect children's lives at multiple levels.

Attachment representations in 7-year-old children at familial high risk of schizophrenia or bipolar disorder: Associations with mental disorders and daily functioning: The Danish High Risk and Resilience Study, VIA 7-A population-based cohort study.

Attachment quality may affect psychological functioning. However, evidence on attachment representations and their correlates in children born to parents with schizophrenia and bipolar disorder is sparse. We compared attachment representations in a Danish sample of 482 children aged 7 years at familial high risk of schizophrenia, bipolar disorder, and population-based controls and examined associations between attachment and mental disorders and daily functioning. Attachment representations were examined with the Story Stem Assessment Profile (SSAP). Mental disorders were ascertained in diagnostic interviews. Daily functioning was assessed with the Children's Global Assessment Scale. We found no between-group differences in attachment. Higher levels of secure attachment were associated with decreased risk of concurrent mental disorders in the schizophrenia high-risk group. Higher levels of insecure and disorganized attachment were associated with increased risk of mental disorders across the cohort. Higher levels of secure and insecure attachment were associated with better and poorer daily functioning, respectively. In the current study, results regarding defensive avoidance could not be reported due to methodological limitations. Familial high risk of schizophrenia (FHR-SZ) or bipolar disorder is not associated with less secure or more insecure attachment at age 7. Insecure and disorganized attachment representations index risk of mental disorders and poorer functioning. Secure attachment may be a protective factor against mental disorders in children at FHR-SZ. Validation of the SSAP is needed.

Association between childhood maltreatment and attachment disorganization in young adulthood: The protective role of early mother-child interactions

BackgroundIndividuals who experience chronic relational trauma within the parent-child relationship are at risk of developing disorganized representations of attachment relationships in the form of Hostile-Helpless (HH) states of mind. While this association is well recognized theoretically, few studies to date have empirically tested predictors of HH states of mind. ObjectiveThe purpose of this study was to examine whether retrospective self-reports of maltreatment and the quality of mother-child affective communication assessed in childhood predict HH states of mind in young adulthood. MethodsThe sample was composed of 66 young adults from a low-income community sample, who had been taking part in a longitudinal project since they were preschoolers. ResultsResults indicate that childhood maltreatment experiences significantly predict HH states of mind and that the quality of mother-child affective communication serves a protective role in the association between childhood maltreatment severity and adult attachment disorganization. ConclusionThis study is one of the first to prospectively examine how the quality of mother-child affective communication in childhood relates to attachment disorganization in young adulthood. Our results highlight the importance of providing support to families in which the child is at risk of experiencing relational trauma, with a particular focus on improving the quality of parent-child interactions.

Does disorganised attachment lead to auditory hallucinations via dissociation? An experimental study with an analogue sample.

Auditory hallucinations (such as hearing voices) are common in clinical and non-clinical populations. Many people who hear voices also report early adversity and have an insecure attachment style. Current cognitive models suggest that dissociation mediates an association between disorganised attachment and auditory hallucinations, but this has not been tested experimentally. We recruited a non-clinical analogue sample highly predisposed to auditory hallucinations and utilised an experimental design to examine the impact of disorganised attachment imagery on hallucinatory experiences, and whether dissociation mediates an expected association. Participants completed self-report measures of state auditory hallucinations and dissociation before and after random allocation to secure or disorganised attachment conditions. Attachment imagery did not affect auditory hallucinations. Both secure and disorganised attachment conditions increased state dissociation. Secure attachment imagery reduced paranoia, but state dissociation did not mediate this effect. An exploratory analysis found that trait dissociation fully accounted for the association between trait-disorganised attachment and hallucinatory experience while controlling for paranoia. Secure attachment imagery reduces paranoia but not auditory hallucinations and the impact on paranoia is not mediated by dissociation. Secure attachment imagery may be useful in reducing fears and distress associated with voices, rather than the frequency or severity of hallucinations. Disorganised attachment may increase hallucinatory experiences for people vulnerable to dissociation. Trait dissociation should be assessed in clinical settings and addressed where indicated as a means of targeting vulnerability to distressing voices.

Suicidal risk among adult survivors of childhood maltreatment: The role of parent–child contact during out of home placement

BackgroundChildhood maltreatment is associated with insecure/disorganized attachment and in turn with suicidal risk (SR). Despite maltreatment, contact with biological parents is maintained during out-of-home placement. However, its impact on SR remains unclear. ObjectiveExamine whether (1) contact with parents is linked with SR and (2) with insecure/disorganized attachment to parents, and whether (3) contact moderates the link between maltreatment and SR and (4) between attachment and SR. MethodNinety-one adults (64 females) placed during childhood passed the Childhood trauma questionnaire (CTQ), the Mini-International Neuropsychiatric Interview (MINI) (for SR), and the Attachment Multiple Model Interview (AMMI). Participants’ records were used to determine contact with biological parents and maltreatment. ResultsResults show that contact with both parents is positively linked with SR. Furthermore, contact with mother moderates (increases) the link between maltreatment and SR. It is also associated with insecure and disorganized attachment and moderates its effect on SR.Conclusions.Findings suggest that decisions to maintain contact with parents could be modulated as a function of attachment to biological parents. They bring new questions about the role of mother–child attachment and whether interventions aimed at improving this relationship are called for when contact is maintained. More research is needed to examine how this may be critical in terms of suicidal risk.

Cross-modal coherence and incoherence of early infant interactive behavior: links to attachment in infants born very preterm or full-term

ABSTRACT Infants exhibit flexibly organized configurations of facial, vocal, affective, and motor behavior during caregiver-infant interactions that convey convergent messages about their internal states and desires. Prior work documents that greater cross-modal discrepancy at 4 months predicts disorganized attachment. Here, we evaluated whether: very preterm (VPT) or full-term (FT) status predicts cross-modal coherence or incoherence in infants’ behavior with the caregiver at 3 months; and, regardless of prematurity, whether cross-modal interactive coherence or incoherence predicts 12-month attachment. Participants included 155 infants (85 FT; 70 VPT), and their mothers followed from birth to 12 months (corrected age). Infants’ cross-modal coherent and incoherent responses were scored microanalytically from videotaped en-face interactions. Infants’ attachment security was evaluated during Ainsworth’s Strange Situation. Infants born VPT exhibited more incoherent cross-modal responses and insecure attachment than infants born FT. Regardless of prematurity, infants’ coherent and incoherent cross-modal interactive behaviors at 3 months predicted different attachment patterns at 12 months.

History of abuse and adolescent hostile-helpless attachment: The mediating role of mother-adolescent punitive interactions

BackgroundHostile-Helpless (HH) state of mind is a form of disorganised attachment that is strongly associated with prior experiences of abuse. However, how abuse experiences contribute toward HH states of mind in late adolescence is unknown. Punitive control in adolescent-mother dyads has been implicated in the development of HH states of mind and adolescent sex/gender may influence how punitive interactions contribute to HH mind states. ObjectiveThe present study aimed to explore how adolescent sex/gender and punitive control within adolescent-mother dyads are related to the links between HH states of mind and childhood abuse. Participants and settingA sample of 109 low-moderate income late adolescents (aged 18–23 years, 65 females, 44 males) and their mothers were assessed in a conflict-resolution paradigm. MethodsRecordings of the interactions were coded using the Goal-Corrected Partnership in Adolescence Coding System for different aspects of attachment-based interactions including punitive control. Late-adolescent HH states of mind features were coded from Adult Attachment Interviews (AAI) and experiences of abuse were coded from adolescent self-reports and the AAI. ResultsModerated mediation analysis revealed a significant indirect pathway from abuse to HH states of mind through punitive control in late adolescent females (B = 0.06, SEBoot = 0.04, 95 % CIBoot 0.01, 0.15), but not males (B = −0.02, SEBoot = 0.02, 95 % CIBoot − 0.07, 0.02). ConclusionsThe results indicate that there are sex/gender-specific pathways to developing HH states of mind. Hostile behavior within mother-daughter dyads therefore may play an important role in linking abuse experiences and contradictory attachment representations in late adolescent females.

The relationship between attachment and posttraumatic stress in children and adolescents: A meta-analytic review.

The relationship between attachment and posttraumatic stress symptoms (PTSS) has been researched extensively within adult samples, with findings consistently demonstrating a relationship between insecure attachment and increased PTSS, and between secure attachment and decreased PTSS. To a lesser extent, such relationships have also been explored within child and adolescent samples. The evidence to date is equivocal and there have been no attempts to synthesize studies. This meta-analysis aimed to provide a quantitative synthesis of studies reporting a relationship between attachment orientation (on both developmental and social psychological measures) and PTSS within children and adolescents. A random effects model was used to pool 30 studies (N = 10,431) reporting exposure to a range of traumatic events including maltreatment and war trauma. Results demonstrate a negative correlation between secure attachment and PTSS (r = -.16) and a positive correlation between insecure attachment (r = .20), avoidant attachment (r = .20), anxious attachment (r = .32), and disorganized attachment (r = .17) and PTSS. These findings indicate a small but significant relationship between attachment and PTSS in children and adolescents. Exposure to maltreatment did not moderate the relationship between secure attachment and PTSS, though strengthened the relationship between insecure attachment and PTSS.

Childhood Trauma and Its Link to Adult Dissociation: The Role of Mentalizing and Disorganized Attachment in a Chinese Adult Sample

ABSTRACT Based on previous findings in a U.S. sample, the present study validated the relationship between childhood trauma and dissociation, as well as the mediating role of disorganized attachment and the moderating role of mentalizing (i.e. self-concept clarity and reflective functioning) in a group of 569 Chinese adults (i.e. a community sample). Results demonstrated a mediating role for disorganized attachment relationships in linking childhood maltreatment and dissociative symptoms. Moreover, self-concept clarity moderated this mediating relationship. An interesting finding that differs from the U.S. sample is that reflective functioning did not play a moderating role between insecure attachment and dissociation in Chinese adults. Chinese culture places greater emphasis on collectivism, altruism, and other-oriented, and thus the protective effect of the reflective function may not be as effective as in an individualistic culture. This study provides evidence for a better understanding of the relationship between childhood trauma, attachment, dissociation, and the moderating role of mentalizing in an Eastern culture, and it opens the door to further research examining whether more Western (such as the U.S.) and Eastern (particularly Chinese) relationships are similar in both social and clinical psychology.

Disrupted maternal communication and disorganized attachment in the Arab society in Israel.

Disrupted maternal communication during mother-infant interaction has been found to be associated with infants' disorganized attachment, but has been studied primarily in North American and European samples and not in Arab samples. To address this gap the study examined the association between disrupted maternal communication and infant attachment in a sample of 50 Arab mothers and their one-year-old infants in Israel. Attachment was assessed with the Strange Situation Procedure (SSP), and disrupted communication with the AMBIANCE. Disrupted communication was higher in mothers of infants with disorganized and ambivalent attachment than in mothers of securely attached infants. The findings support the link between disrupted communication and disorganized attachment in the Arab society in Israel and add to our understanding of maternal behavior associated with ambivalent attachment.

Holding a foster child’s mind in mind: study protocol for a cluster-randomized controlled trial of mentalization-based therapy (MBT) for foster families

BackgroundChildren in foster care are psychologically vulnerable and show more social, developmental, and behavioral problems than those living with their family of origin. Many foster parents struggle to care for these children, some of whom have experienced severe adversity. Research and theory suggest that developing a strong and supportive foster parent–child relationship is essential for foster children to become more well-adjusted and experience a decrease in behavioral problems and emotional maladjustment. Mentalization-based therapy (MBT) for foster families aims at increasing the reflective functioning of the foster parents, thus promoting the development of more secure and less disorganized child attachment representations, which is subsequently proposed as a factor that reduces behavioral problems and emotional maladjustment in children and promotes their overall well-being.MethodsThis is a prospective cluster-randomized controlled trial with two conditions: (1) the intervention group participating in MBT, and (2) the control group who receive usual care. Participants are 175 foster families with at least one foster child aged 4–17 years with emotional or behavioral problems. The intervention will be offered to foster families by 46 foster care consultants from 10 municipalities in Denmark. The foster care consultants will be randomized to MBT training (n = 23) or usual care (n = 23). The primary outcome is the psychosocial adjustment of the foster child measured by the Child Behavior Checklist (CBCL) as reported by foster parents. Secondary outcomes include child well-being, parental stress, parent mental health, parent reflective function and mind-mindedness, parent/child relations, child attachment representations, and placement breakdown. In order to explore implementation fidelity as well as practitioner experiences, we will administer questionnaires designed for this study and conduct qualitative research exploring the practice of the MBT therapists.DiscussionThis trial is the first experimental study of a family therapeutic intervention based on attachment theory for foster families within the Scandinavian context. This project will contribute with novel knowledge on attachment representations in foster children and the effects of an attachment-based intervention on essential outcomes for foster families and children.Trial registration ClinicalTrials.gov NCT05196724. Registered on January 19, 2022.

In defense of unresolved attachment: re-modelling intergenerational transmission of attachment

ABSTRACT Intergenerational transmission of attachment is one of the core hypotheses of attachment theory. How parents or other caregivers look back on their childhood attachment experiences is suggested to shape their infants’ attachments. In the current paper, we show that a new twist to correspondence analysis (Canonical Correlation Analysis [CCA]) of cross-tabulated attachment classifications with oblique rotation Correspondence Analysis (CA) may uncover the latent structure of intergenerational transmission showing the unique role of parental Unresolved representations in predicting infant Disorganized attachments. Our model of intergenerational transmission of attachment supports predicted associations between parental and infant attachments. Despite growing skepticism about the validity of parental Unresolved trauma and infant Disorganized attachment, we come to an evidence-based statistical defense of these generative clinical components of attachment theory awaiting a substantive experimentum crucis.

Screening and early therapeutic intervention of bonding disorders at first six months of life: An alternative to prevent disorganised attachment and severe mental disorder

IntroductionDisorganized attachment has been described as an important risk factor for developing serious mental disorders in childhood, adolescence and adulthood, such as borderline personality disorder, psychoses, afective disorders, and a higher suicide risk, for instance. Bonding disorders (BD) in parents are related to insecure and disorganized attachment in children. BD can be early diagnosed at 4 to 6 weeks after birth.ObjectivesDetermine if there is a significant difference between the results of the prevalence of affective disorders, disorganized attachment, and suicidal risk five years after the birth of the offspring of parents with and without attachment disorders detected in the first year postpartum during the covid-19 pandemic.MethodsDescribe a pilot project of an analytical prospective study following a cohort of parents from the cohort SAMPECO/PEMHSCO (Perinatal Mental Health in Spain during the Covid-19 pandemic). The cohort is planned to be divided into two groups: with bonding disorders an without bonding disorders, which was established using the Postpartum Bonding Questionnaire (Brockington, 2006). Follow the offspring of both groups for 5 years and compare the results of disorganized attachment, affective disorders and suicide risk.ResultsThe cohort SAMPECO/PEMHSCO was recruited between March 2021 and June 2022. There was measured postpartum depression in mothers and fathers using the EPDS and bonding disorders in parents using the PBQ validated to the Spaniard population. More than 1500 families were involved at the beginning and around 450 families finished the follow-up six months after birth. Around 500 families were lost because of non-right contact information.ConclusionsThe covid-19 pandemic has seriously affected the mental health of the general population. Consequently, there is a higher demand for mental health assistance by public and private sanity sectors. Currently, the youth population is suffering very much from the consequences of isolation and other social factors, and many families who had babies in this period haven’t had enough support to breed and look after both their babies and themselves. Some papers suggest that the prevalence of perinatal mental disorders in parents has increased since the covid-19 pandemic because of several factors. Paradoxically, despite the high preventive potential of early intervention in the perinatal period, there are not yet exist well-equipped perinatal mental health units to solve this problem. It is urgent to boost the development of Perinatal Mental Health Services to prevent a major worsening of the situation and to prevent the increasing rate of severe mental disorders in children, adolescents and adults.Disclosure of InterestNone Declared

Attachment security in children with disability or developmental delay: Systematic review of quality and interventions

ABSTRACT Secure attachment has broad and long-lasting benefits for the development and wellbeing of a child. Conversely, disorganized attachment is associated with social, emotional, and behavioral problems in children, and later psychopathology. Children with a developmental delay or disability (DD) may be at greater risk of insecure or disorganized attachment than children without DD. This systematic review aims to (1) synthesize the available evidence worldwide regarding attachment and children with DD and (2) to examine the effectiveness of interventions employed to prevent or address attachment insecurity for this population. Peer reviewed articles with four-fold attachment classification data or attachment interventions for children with DD were included in the review. Seventeen databases were searched for studies published in English from January 1980 to January 2019. The systematic review protocol was registered a priori with PROSPERO (CRD42018117574). Twenty-three articles met the inclusion criteria, nine containing strange situation procedure (SSP) data and 14 relating to interventions. Meta-analysis was conducted with data from six of the SSP articles (n = 215). The remaining articles were reviewed narratively. Results indicate that children with DD are significantly less likely to develop a secure attachment and significantly more likely to develop a disorganized attachment than children without DD. Emerging research indicates promise that early intervention may be effective in improving attachment security.

Disorganized attachment and physical health

ZusammenfassungHintergrundDie Bindungsforschung hat empirisch gezeigt, dass frühe Beziehungserfahrungen nicht nur für die psychosoziale, sondern auch für die körperliche Entwicklung hoch relevant sind. Während Zusammenhänge zwischen den Dimensionen der „organisierten“ unsicheren Bindung, Angst und Vermeidung, mit körperlichen Erkrankungen gut belegt sind, ist die Studienlage für Merkmale einer desorganisierten Bindung bislang unzureichend.MethodeIn einer Allgemeinbevölkerungsstichprobe von 1101 Teilnehmenden wurden mithilfe von Selbstbeurteilungsskalen desorganisierte Bindung in Partnerschaften und desorganisierte Kindheitsbeschreibungen erfasst. Die Zusammenhänge mit ärztlich diagnostizierten Erkrankungen und der Krankheitslast insgesamt wurden mithilfe von Regressionsmodellen untersucht. Die Analysen erfolgten unter Kontrolle relevanter soziodemografischer Variablen sowie der Risikofaktoren Rauchen, riskanter Alkoholkonsum und Body-Mass-Index.ErgebnisseHinsichtlich der Krankheitsgruppen waren neurologische Erkrankungen konsistent sowohl mit desorganisierter Bindung in der Partnerbeziehung als auch mit selbstbeurteilten desorganisierten Kindheitsbeschreibungen assoziiert. Es zeigten sich Zusammenhänge zwischen desorganisierter Bindung und Krankheitslast, die unabhängig von den Dimensionen der „organisierten“ unsicheren Bindung, Angst und Vermeidung, bestanden.DiskussionPersonen mit desorganisierter Bindung weisen eine schlechtere körperliche Gesundheit auf, wobei die genauen Mechanismen in weiteren Studien untersucht werden sollten. Die Ergebnisse deuten darauf hin, dass in der psychotherapeutischen Behandlung dieser PatientInnen die körperliche Gesundheit nicht außer Acht gelassen und gesundheitsfördernde Verhaltensweisen gestärkt werden sollten.

A systematic review of measures of adult disorganized attachment.

Disorganized attachment has been identified as an important factor in the development and maintenance of mental health problems. Further research is required to understand the mechanism by which this attachment pattern predisposes individuals to develop, and maintain, personal and social difficulties and mental health problems utilizing valid and reliable measurement tools. The assessment of adult disorganized attachment is therefore important for both applied psychologists and researchers. We conducted a systematic review using the COSMIN guidelines to identify and critically appraise instruments which measure adult disorganized attachment. A systematic database search was performed using MEDLINE, EMBASE, Web of Science, PsychInfo and CINHAL in accordance with PRISMA guidelines. Database searching provided 5757 results, with 18 measures identified across 27 eligible papers which were critically evaluated. Measurement properties were promising for the Childhood Disorganization and Role Reversal Scale, Psychological Treatment Inventory-Attachment Styles Scale, Attachment Style Questionnaire - Short Form and the Adult Attachment Interview. However, overall, due to inconsistent quality of methodology and reporting of results, it is challenging to reach sufficient conclusions and suggestions regarding the best instrument to use to measure adult disorganized attachment. The Childhood Disorganization and Role Reversal Scale, Psychological Treatment Inventory-Attachment Styles Scale. Attachment Style Questionnaire-Short-Form and Adult Attachment Interview are the best available measures of disorganized attachment in adulthood. This review highlights the need for further psychometric testing of existing measures, or development of new instruments, grounded in sound methodology.